The term New Public Management (NPM) is used internationally in academic, governmental and organizational discussions, but it is rarely defined. In this chapter it is defined in three ways. First, as a movement; that is a set of beliefs or ideology from which actions followed in anticipation of particular consequences. It emerged in the 1980s among politicians and their advisers in countries where governments, at national, regional or local level, had strong traditions of directly organizing, providing and managing publicly funded, public services. Second, as a subject for study and commentary by academics. Third, as a set of practices that can be observed in recent public sector reform. This chapter assesses New Public Management after two decades which have seen its expansion and diversification in each of these three guises. Our aim is to reflect on the developments in NPM in terms of what it means for commentators on, and practitioners in, public services.

The health sector in the UK is the main vehicle for discussion. It has arguably undergone some of the most extensive NPM reform in the UK. This chapter explores the evidence for some of the assumed relationships between ideology, actions and consequences in NPM as they are found or not found in UK health services. It examines themes, issues and dilemmas that are revealed and asks what NPM means today, and whether its continuation and development relate in any way to its ability to deliver its promises in terms of cost containment, quality improvement and public support. Finally, we address the consequences of NPM for those working in public sector organizations.

NPM as a movement

The core of the ideology which can be discerned as influential in the development of public sector reform programmes in the 1980s and 1990s is that public sector provision was inefficient and often ineffective; that it led neither to cost containment nor to quality improvement; that it opened the way to undue influence for employees (whether they were protected by virtue of their membership of professional associations or of mass trade unions); and that, if

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